Evaluation of risk factors of late Periprosthetic joint infection: A retrospective study

Abstract

Background: Prosthetic Joint Infection that develops at a variable length of time after an index joint replacement procedure is known as LateProsthetic Joint Infection.There must be an asymptomatic period clinical and/or radiographic signs, after an initially successful index procedure. The current study aims to retrospectively identify the risk factors for late PJI following primary total joint arthroplasty and classify those significant risk factors as either non-modifiable or potentially modifiable for intervention prior to surgery. Till date not many studies has been done in Indian subcontinent, which prompted us for the study. Material and Methods: We report our experience in 33 cases of Late PJI and its causative factors including microorganisms and its subsequent management, of deep infection following over 5000 primary joint replacements carried out over 6 years (2013 may to 2019 September) at IMS & SUM Hospital, Bhubaneswar. All patients were followed up for delayed PJI for a minimum period of one year postoperatively involving review of all readmissions, returns to the operating room, positive cultures, morbid obesity, UTI, dental procedures, UGI endoscopy, skin diseases etc. Results: Significant risk factors for late PJI after primary TJA included active tobacco use, diabetes and related comorbidities, S. aureus colonization, UTI, morbid obesity, skin diseases, UGI endoscopy, male gender, age>=55yrs. These risk factors can be broadly divided into modifiable and non-modifiable risk factors. Modifiable risk factors like such active tobacco use and S. aureus colonization can be eliminated to reduce the incidence of late PJI. Conclusion:The current study aims to identify the risk factors of late PJI after primary arthoplasty, thus patients can be counselled properly prior to undergoing TJA, which should help them make treatment decisions regarding these procedures. Apart from this the modifiable risk factors can be addressed prior to surgery, thus the overall incidence of late PJI can be reduced.